General conditions
Set of contractual clauses previously prepared and presented by the insurer. They include the basic aspects of the insurance contract that are typical for risks with similar characteristics. They define, for example, general coverages and exclusions and the rights and duties of the parties.

Special conditions
Set of clauses that complement or specify the general conditions. The special conditions (usually additional coverages), which are actually contracted, are identified in the specific conditions.

Individual conditions
Set of clauses that adapt the contract to the specific situation of a policyholder. They identify, in particular, the coverages contained in the special conditions that were chosen, the values of the insured capital that were agreed, the deductibles that the parties established, the beneficiaries, the relevant characteristics of the person or insurance plan, and the effective date of the contract.

Source: ASF - Supervisory Authority of Insurance and Pension Funds.

Health insurance covers risks related to health care services, according to the coverage provided for in the terms of the contract and withing the limits set therein.

Source: ASF - Supervisory Authority of Insurance and Pension Funds.

Pre-existing illnesses, known to the insured person at the date of the contract, are considered to be covered by insurance if not expressly excluded in the contract. However, it is usual for this exclusion to be included in contracts.

The contract may also indicate a grace period, not exceeding one year, for the coverage of pre-existing illnesses.

Source: ASF - Supervisory Authority of Insurance and Pension Funds.

The policyholder and the insured person are obliged to:

• inform the insurer about the circumstances and consequences of the accident or illness;
• follow the instructions of the attending physician;
• subject themselves, if necessary, to examination by a doctor appointed by the insurer;
• provide proof of expenditure on prescribed and necessary health care;
• whenever possible, request prior authorization from the insurer for hospitalization.

Source: ASF - Supervisory Authority of Insurance and Pension Funds.

They can be paid through a reimbursement system or a system of direct payment to service providers that have an agreement with the insurer (i.e. providers belonging to an agreed network).

Source: ASF - Supervisory Authority of Insurance and Pension Funds.

In a reimbursement system, expenses are paid by the insured person and then reimbursed by the insurer.

The insurance contract states:

• the maximum percentage of reimbursement (i.e., maximum amount paid by the insurer);
• the capital available for each coverage;
• the amount of the initial deductible for each coverage, if any;
• the maximum period for repaying the requested expenses, starting on the date on which they were made;
• the maximum term to reimburse the insured person.

Source: ASF - Supervisory Authority of Insurance and Pension Funds.

In a system where the insurer pays the service providers in the agreed network directly, the insured person, when using doctors, hospitals, laboratories, etc., from the list provided with the contract, only pays the part of the expense that is not covered by insurance.

The insurer's share is paid directly to those service providers.

Source: ASF - Supervisory Authority of Insurance and Pension Funds.